Endometrioma Recurrence Research Articles

Risk factors for recurrence of ovarian endometriomas after surgical excision

Ovarian endometrioma is a common form of endometriosis, which may cause infertility, dysmenorrhea and pelvic pain in women of reproductive age. Although surgery is the treatment of choice for endometriomas, recurrence poses a formidable frustration. This study investigated potential risk factors of endometriomas recurrence, aiming to better understand its pathogenesis. A total of 307 patients with endometriomas were followed up for an average of 28.6 months and the 1-, 2- and 3-year cumulative recurrence rate was 9.5%, 21.9%, and 29.2%, respectively. Twenty-one potential risk factors for endometriomas recurrence were evaluated using Cox's proportional hazards models. Total revised American Fertility Society (rAFS) score was significantly associated with higher recurrence (OR=1.858, 95% CI=1.122-3.075, P=0.016), as well as younger age at surgery (OR=0.953, 95% CI=0.915-0.992, P=0.020). Semiradical surgical treatment was defined as surgical removal of cyst plus hysterectomy with preservation of bilateral or unilateral ovary, and was a significant factor that was associated with lower recurrence than the conservative surgery (OR=0.318, 95% CI=0.107-0.951, P=0.040). Postoperative pregnancy was favorable factors for disease recurrence (OR=0.217, 95% CI=0.102-0.460, P=0.000). The results suggest that endometrioma recurrence is inversely associated with age at surgery and postoperative pregnancy, and may correlate with total rAFS score and conservative surgery method.

Ovarian stripping versus cystectomy: recurrence of endometriosis and pregnancy rate

To compare two different surgical techniques, stripping or cystectomy, in patients treated with the same post-operative medical therapy in terms of recurrence of endometrioma, recurrence of pain and spontaneous pregnancy rate within 2 years from surgery. The inclusion criteria of this study were: (1) 25-40 years old; (2) ovarian endometrioma more than 3 cm of diameter detected by transvaginal ultrasonography (3) regular menstrual cycle (4) post-operative treatment with GnRH analogs, (5) tubal patency assessed by laparoscopic chromopertubation (6) normal human semen characteristics. Exclusion criteria were uterine myoma, previous medical treatment for endometriosis, presence of adenomyosis, previous surgery of ovarian endometrioma, multiple cysts, bilateral involvement, co-existence of deep endometriosis. Patients were assigned to two study groups: group A (N = 45) patients undergoing stripping technique and group B (N = 64) patients undergoing cystectomy technique for ovarian endometrioma. In group B the percentage of ultrasonographic recurrence (15.4 %, N = 15) is much lower than in group A (55.6 %, N = 25). (p value 0.001). In group B the percentage of symptomatic recurrence (21.8 %, N = 14) is much lower than in group A (53.3 %, N = 24) (p value 0.001). Spontaneous pregnancy rate in group A patients was of 4.4 % (N = 2) and in group B 22.3 % (N = 21), (p value 0.0072). However, the percentage of specimen with adjacent healthy ovarian tissue was lower in group A (26.6 %) than in group B (50 %) (p value 0.01). Among the different treatment options for surgical treatment of ovarian endometrioma, in our experience cystectomy appears to be the most appropriate treatment, both in terms of recurrence and pregnancy rate.

Surgical therapy of ovarian endometrioma: recurrence and pregnancy rates.

Background and Objectives:The study was designed to analyze preoperative clinical and surgical findings at enucleation of ovarian endometrioma with their impact on recurrence and pregnancy rates.Methods:This is a retrospective study of 550 histologically verified ovarian endometriomas operated on at the Department of Obstetrics and Gynecology, University Hospital Kiel, Germany, between 1995 and 2004. Preoperative data, surgical findings, and postoperative outcomes of 289 cases were analyzed. The average follow-up period was 12.9 years.Results:Ovarian endometriomas recurred in 23.9% of patients. Risk factors identified for recurrence of endometriomas were preoperative pain (P = .013), dysmenorrhea (P = .013), larger cyst size (>8 cm), younger age (<25 years), and preoperative cyst rupture. Factors associated with postoperative dysmenorrhea were younger age <25 years (P < .001), nulliparity (P = .020), and lager cyst size >8 cm (P = .048). Recurrence of pain was influenced by previous surgery of endometrioma (P < .05). Laparoscopy had a higher percentage of symptom-free patients than laparotomy did (49.0% vs 33.3%). Additional postoperative hormonal treatment resulted in a higher spontaneous pregnancy rate (41.4% vs 12.6%; P < .001) but a lower recurrence-free interval rate (70.5% vs 82.6%; P = .050) when compared with surgery only.Conclusions:We identified preoperative and intraoperative findings associated with higher risk of recurrence of endometrioma, pain, and dysmenorrhea. Patients desiring pregnancy benefited from postoperative hormone treatment, but no favorable results from combined therapy were observed with regard to recurrence rate.

Rapid Recurrence of Unilateral Endometrioma in a Teenager with a Noncommunicating Rudimentary Horn and Unicornuate Uterus

A 17-year-old nulligravida woman presented to the emergency department complaining of a six months’ history of severe dysmenorrhea. The patient underwent a laparoscopic excision of a right ovarian endometrioma in another hospital one year ago, 24 months after menarche at 14 years of age. Transvaginal ultrasonography, magnetic resonance imaging, hysteroscopy as well as laparo- scopy revealed a unicornuate uterus with a noncommunicating right rudimentary horn, a dilated right fallopian tube and a novel 40 mm right ovarian endometrioma. An excision of the right fallopian tube, the rudimentary horn and the endometrioma was performed. Since endometriosis may be originated by retrograde menstruation, an obstructive müllerian malformation should be ruled out at the diagnosis of endometriosis, particularly in adolescents. It may lead clinicians to provide an initial definitive treatment for avoidingrapid recurrent endometriosis.

Postoperative levonorgestrel‐releasing intrauterine system versus oral contraceptives after gonadotropin‐releasing hormone agonist treatment for preventing endometrioma recurrence

Although the levonorgestrel-releasing intrauterine system (LNG-IUS) is effective in reducing the recurrence of endometriosis-associated pain, its efficacy in preventing endometrioma recurrence is questionable. We compared the efficacy of postoperative use of LNG-IUS with oral contraceptives (OC) for preventing endometrioma recurrence. A retrospective cohort study. Medical university hospital. Ninety-nine women with endometriomas. A chart review was performed of women of reproductive age who had undergone laparoscopic surgery for endometrioma followed by three cycles of gonadotropin-releasing hormone agonist (leuprolide acetate) treatment. Women were categorized into two groups: a group that had postoperative LNG-IUS placement (n = 42) and a group that received postoperative, cyclic, low-dose, monophasic, OCs (n = 57). Main outcome measures. Endometrioma recurrence was analyzed according to several clinical variables and postoperative treatment modalities. During the follow-up period (median 17 months), recurrent endometriomas were detected in eight women (8.1%). Patients with LNG-IUS had a recurrence rate of 4.8% (2/42), whereas women receiving OC had a recurrence rate of 10.5% (6/57). Cumulative recurrence-free survival assessment revealed that mean disease-free survival times for both groups were similar, but that for LNG-IUS was slightly longer than that for OC, with statistical significance (34.4 ± 1.0 months, 95% confidence interval 32.3–36.5, vs. 33.4 ± 1.3 months, 95% confidence interval 30.8–36.0, p = 0.045). Univariate analysis revealed a hazard ratio of 0.178 (95% confidence interval 0.029–1.075) (p = 0.060) for postoperative LNG-IUS use and endometrioma recurrence. However, for the multivariate regression analysis, only postoperative serum CA 125 levels were significantly associated with endometrioma recurrence (hazard ratio 1.012, p = 0.010). Postoperative LNG-IUS use seemed to be comparable to the use of cyclic OC in preventing endometrioma recurrence.

Recurrence of ovarian endometrioma after second-line, conservative, laparoscopic cyst enucleation

We sought to evaluate the cumulative recurrence rate of endometrioma after a second-line, conservative, laparoscopic endometriotic cyst enucleation and to analyze the factors that influence the recurrence of endometrioma. A multicenter retrospective cohort study was performed at 3 gynecologic surgery centers from January 2000 through December 2010. Patients surgically treated by laparoscopic enucleation of endometriotic cysts on 2 previous occasions were selected. All patients were aged <40 years at the time of the primary surgery and were followed up for at least 6 months. Endometrioma recurrence was considered when transvaginal sonography indicated a cystic mass with a diameter of ≥20 mm. In total, 183 patients were followed up for 33.2 ± 27.7 months (range, 6-121 months). Thirty-eight (20.8%) patients experienced recurrence after the second-line surgery and 24 (13.1%) patients underwent a third surgery. The median time to recurrence was 24 ± 3.36 months (SEM) (range, 3-72 months). The cumulative recurrence rates per patient at 12, 24, 36, and 60 months after the second-line surgery were 7.7%, 13.7%, 21.3%, and 37.5%, respectively. After multivariate analysis and analysis of covariance, the revised American Fertility Society score and stage were significantly higher in patients who experience a third recurrence of endometrioma. The cumulative recurrence rate of ovarian endometrioma after a second-line surgery appears to be correlated to the duration of follow-up. Severe endometriosis at the second-line surgery seems to be a factor associated with a high recurrence risk. Physicians should be cautious with regard to the postoperative management of these patients.

Surgical treatment of rectovaginal endometriosis with extensive vaginal infiltration: results of a systematic three-step vagino-laparoscopic approach

ObjectiveRecto-vaginal endometriosis remains a surgical challenge. We propose a systematic surgical approach combining vaginal and laparoscopic steps for patients affected by deep endometriosis infiltrating the vaginal wall. Study designThis is a prospective observational study, performed at Campus Bio-Medico of Rome, University Teaching Hospital. All consecutive patients, from 2008 to 2011, affected by symptomatic deep recto-vaginal endometriosis with full thickness vaginal wall involvement, underwent a systematic surgical approach, based on three consecutive surgical steps: vaginal route, laparoscopic approach and final vaginal excision. All patients included in the study were scheduled for two years’ follow-up with pelvic examination, transvaginal ultrasound and visual analog scale (VAS) evaluation of symptoms (dysmenorrhea, dyspareunia and chronic pelvic pain) at 3, 6, 12 and 24 months. ResultsThirty-four patients were enrolled. No major complications were registered. Complications included superficial vascular lesions in two cases (5.9%), ureteral stenosis two weeks after surgery in one patient (2.9%), and bowel obstruction for paralytic ileus in one patient (2.9%). A de novo endometrioma was found at 12 months after surgery and a recurrent endometrioma was evident at 24 months. For all symptoms evaluated, there was a significant improvement within 3 months after surgery (p<0.05) and no statistically significant difference during follow-up (at 3, 6, 12 and 24 months). ConclusionThe proposed systematic surgical approach consisting of three consecutive steps could simplify the approach to deep endometriosis while at the same time increasing the quality of endometriosis surgery, with important benefit for the women affected.

Second Surgery for Recurrent Endometriomas Is More Harmful to Healthy Ovarian Tissue Than First Surgery

Second Surgery for Recurrent Endometriomas Is More Harmful to Healthy Ovarian Tissue Than First Surgery

Recurrence of ovarian endometrioma after laparoscopic excision: Risk factors and prevention

The aim of this study was to assess the cut-off age of the risk factors for postoperative recurrence of ovarian endometriomas and to evaluate the end-points of follow-up after laparoscopic excision of ovarian endometriomas. We retrospectively reviewed 167 patients who underwent laparoscopic excision of ovarian endometriomas at our hospital between 2000 and 2009, and followed up the patients until 2010. Following surgery, patients chose to receive gonadotrophin-releasing hormone agonist, oral contraceptive pills (OCP), dienogest, or no medication and underwent regular ultrasonographic examinations. Potential risk factors for recurrence, including age at surgery, were assessed in the patients receiving no medication. Postoperative recurrence, defined as re-appearance of an ovarian endometrioma > 2 cm in size, was assessed for each treatment group. Age at surgery was the only significant risk factor for recurrence, at a cut-off of 32 years, obtained through receiver-operator curve analysis. In patients not receiving medication, the recurrence rate gradually increased up to 50% over 5 years; there was no recurrence 5 years after surgery. Although no recurrence was seen in patients during continuous treatment with OCP or dienogest, the disease recurred in 55.5% of patients after discontinuing OCP. Although adjuvant therapy for all patients may represent overtreatment, the findings of the present study suggest that, in the interest of fertility preservation, continuous postoperative hormonal treatment should be administered, at least to patients younger than 32 years. In patients who decline hormonal treatment, we recommend that they undergo follow-up for recurrence until 5 years after surgery.

Factors associated with the laterality of recurrent endometriomas after conservative surgery

We evaluated the laterality of primary endometrioma and characteristics of patients according to the laterality of recurrent endometrioma in 140 women with recurrent endometrioma after conservative surgery. Histologically confirmed recurrent endometriomas were found on the left side in 49 patients (35.0%), the right in 44 (31.4%) and bilaterally in 47 (33.6%). The sites of primary endometrioma were not associated with those of recurrent endometrioma, and the recurrence rate in the treated ovary (59.8%) was similar to that of the intact ovary (69.0%) at the primary surgery. Proportions of stage IV endometriosis and posterior cul-de-sac obliteration were higher in patients with bilateral recurrence than in those with unilateral recurrence (p < 0.01 for all comparisons) and in patients with contralateral recurrence than in those with ipsilateral recurrence (p < 0.05 for all comparisons), but no differences were found in other characteristics of participants according to the laterality or pattern of recurrence. In conclusion, the lateral distribution of recurrent endometrioma was not associated with that of the primary lesion, and endometrioma did not recur more frequently in the treated ovary. An advanced stage and the presence of posterior cul-de-sac obliteration were factors associated with bilateral or contralateral recurrence of endometrioma.

Ultrasound-Guided Aspiration and Ethanol Sclerotherapy (EST) for Treatment of Cyst Recurrence in Patients after Previous Endometriosis Surgery: Analysis of Influencing Factors Using a Decision Tree

Study ObjectiveTo evaluate the efficiency of transvaginal aspiration accompanied by ethanol sclerotherapy for treating cyst recurrence in patients who have previously undergone surgery to treat endometriosis and to analyze various factors that influence success rates using a data mining system. DesignRetrospective cohort study (Canadian Task Force classification II-3). SettingTeaching hospital affiliated with Chang Gung University, Taoyuan, Taiwan. PatientsOne hundred ninety-six patients with endometrioma recurrence. InterventionA total of 274 transvaginal aspirations followed by sclerotherapy with 95% ethanol. Treatment times varied from immediate removal (0–10 minutes) to in situ retention. Patients were followed up at 3, 6, and 12 months to detect complications, determine the size and persistence of cysts, obtain the pelvic pain score, and assess for pregnancy or the need for repeat surgical intervention. A decision tree was used to determine factors from the collected data that most influenced the success of treatment. Measurements and Main ResultsCyst size was consistently reduced until 6 months after ethanol sclerotherapy. The mean (SD) cyst reduction rate was 37.2% (42.2%), and the pain score reduction rate was 20.5% (71.5%). The antral follicle count was simultaneously increased by 36.4%. Sixty-three patients (23%) required repeated surgery during the observation period and were treated with either repeat aspiration (13.5%) or major laparoscopic or open laparotomic interventions (8.4%). Eighteen of 101 infertile patients (17.8%) achieved pregnancy. The total recovery rate (pregnancy or no persistence of symptoms or cyst) was significantly higher in patients in the groups that received longer treatment (7–10 minutes and retention) than in the groups with shorter treatment (0–6 minute) (47.0% vs 28.7%; p < .005). The highest recovery rate was observed in patients with longer treatment time, smaller cysts (≤5.05 cm), lower CA 125 level (≤62.03 IU/mL), and fewer cysts (≤3 cm) (35 of 49 [71.4%]). In patients with larger cysts and cysts with clear contents, better success can be achieved with longer treatment. The use of postoperative ovarian suppression, traditional Chinese medicine, or no therapy for 6 months before the study was not significant among groups. ConclusionUltrasound-guided sclerotherapy with 95% ethanol retention is an effective alternative therapy for recurrent ovarian endometrioma, in particular in selected patient groups.

Effect of Long-Term Use of Hormones on Endometriomas

Surgery remains the standard treatment for endometriomas larger than 3 cm. Three to six months of hormonal treatment administered preoperatively does not facilitate surgery; additionally, treatment taken postoperatively delays but does not prevent endometrioma recurrence and thus does not offer substantial long-term advantages. Nevertheless, postoperative long-term continuous use of oral contraceptives results in a 90 % reduction in cyst recurrence compared with no treatment. The possible mechanisms of action of oral contraceptives in preventing endometrioma recurrence include hypomenorrhea, ovulation inhibition and improvement of progesterone resistance. Further studies are needed to assess whether long-term use of oral contraceptives might be effective in the treatment and prevention of endometriomas without surgery.

Laparoscopic Ovarian Cystectomy versus Fenestration/Coagulation or Laser Vaporization for the Treatment of Endometriomas: A Meta-Analysis of Randomized Controlled Trials

Aim: To compare outcomes after laparoscopic ovarian cystectomy versus fenestration/coagulation or laser ablation for the treatment of endometriomas. Methods: Studies were identified by searching the PubMed, EMBASE, SCOPUS, and Cochrane Central Register of Controlled Trials databases using the terms ovarian, endometrioma or endometriosis, cystectomy, fenestration, coagulation, laser, and ablation or vaporization. The outcomes of interest were recurrence of signs/symptoms and endometrioma, reoperation, pregnancy, and ovarian reserve. Results: Seven studies were included. The risk of recurrence of signs/symptoms after surgery was significantly lower for laparoscopic cystectomy compared with fenestration/coagulation [risk ratio (RR): 0.29; 95% CI: 0.15-0.55; I² = 0%; p < 0.001], as was the risk of recurrence compared with fenestration/coagulation (RR: 0.50; 95% CI: 0.26-0.97; I² = 0%; p = 0.04) and laser vaporization (RR: 0.33; 95% CI: 0.12-0.88; I² = 0%; p = 0.03). The risk of pregnancy was significantly higher for cystectomy compared with fenestration/coagulation (RR: 2.64; 95% CI: 1.49-4.69; I² = 0%; p < 0.001), but not laser vaporization (RR: 0.92; 95% CI: 0.30-2.80; p = 0.89). There were inadequate data for the meta-analysis of ovarian reserve. Conclusions: Our findings suggest that cystectomy provides better outcomes than fenestration/coagulation or laser ablation regarding recurrence of symptoms and endometrioma as well as pregnancy rate (fenestration/coagulation only). Further studies are needed to clarify the effect of these surgical approaches on ovarian reserve.

Oral contraceptives in the prevention of endometrioma recurrence: does the different progestins used make a difference?

The primary aim of the study was to analyze the endometrioma recurrence rate in patients who underwent laparoscopic excision followed by postoperative long-term regimen of oral contraceptives (OCs). 168 patients who underwent a conservative laparoscopic surgery for endometrioma, during the period between September 2009 and August 2010 in three university hospitals were studied. A long-term OCs therapy was offered to all women following surgery. Patients were randomly divided into three groups according to different progestins used (desogestrel, gestodene, dienogest). Women who refused a postoperative hormonal therapy served as control. Follow-up visits and transvaginal scan were planned at 1, 3, 6, 12, and 24months after surgery. All patients who showed an ultrasound persistence of the endometrioma at 1month follow-up were excluded from clinical analysis. Of the 168 patients, 131 completed the 24months follow-up. Endometrioma recurrence was found in 21 (12.5%) of all patients, it was unilateral in 17 cases while bilateral in 4 cases. The rate of recurrent endometrioma was statistically significant in non-users compared to the long-term OCs treated patients. The current data suggest the usefulness of long-term OCs regimen after conservative surgery for the prevention of ovarian endometrioma recurrence. As a statistical significant difference could not be observed between OCs groups, further study on the individual molecules is required in order to really understand the effect of each of them.

Role of Surgery in Endometriosis-Associated Subfertility

Analysis of published series reveals that no more than a fourth of subfertile patients undergoing surgery for peritoneal endometriotic implants, rectovaginal endometriotic lesions, or recurrent endometriomas achieved conception spontaneously. First-line surgery for ovarian endometriotic cysts appears associated with a better reproductive performance, that is, a mean postoperative pregnancy rate of ∼50%. At the same time, excision of endometriomas paradoxically seems to induce gonadal damage. With the exception of peritoneal disease, no randomized trials are available to assess the effect of surgery in subfertile women with endometriosis. Therefore, it is not possible to define the absolute benefit increase of the treatment of ovarian and rectovaginal lesions. The decision to undergo surgery for endometriosis-associated subfertility must be shared with the woman after detailed information and taking into account several additional conditions, such as presence of pain, large or complex adnexal masses, bowel or ureteral stenosis, and coexisting infertility factors. When considering surgery, a therapeutic equipoise should be reached that includes demonstrated benefits, potential morbidity, and costs of treatment alternatives. Particularly in case of recurrent endometriosis, in vitro fertilization should generally be preferred to surgery. The role of surgery in endometriosis-associated subfertility includes temporary pain relief in symptomatic women desiring a spontaneous conception.

Clinicopathologic risk factors for recurrence of ovarian endometrioma following laparoscopic cystectomy

To identify epidemiologic risk factors and investigate whether the characteristics of removed ovarian tissue during surgery influence the recurrence of endometriomas. Retrospective cohort study. Medical university hospital. 248 women with endometriomas. All women who had a minimum of 2years of follow-up after the laparoscopic excision of endometriomas were analysed retrospectively. Specimens were analysed histologically. Sixteen epidemiologic variables were analysed as possible risk factors for recurrence. The association between the characteristics of removed ovarian tissue (the thickness of the cyst wall, the thickness of ovarian tissue, and the morphological features) and endometrioma recurrence was investigated. The cumulative incidence of endometriomas reached 42% at 60months after surgery. We identified only a younger age at surgery as a risk factor, and postoperative pregnancy as a preventive factor. There were no differences in the mean thickness of the cyst wall and the removed ovarian tissue between patients with and without recurrence. No statistically significant associations were found between the morphologic characteristics of removed cyst wall, ovarian tissue, graded on a semi-quantitative basis, and recurrence. These results suggest that the rate of endometrioma recurrence had a significant relation to patient age and postoperative pregnancy; however, there was no association between the histological characteristics of the excised tissue and recurrence.

Recurrence of endometrioma after laparoscopic excision and its prevention by medical management

Laparoscopic excision is considered as the 'gold standard' treatment of ovarian endometrioma. However, a frustrating aspect is that disease can recur. While laparoscopic excision is known to improve fertility, recurrence can cause significant ovarian damage and adverse affects on fertility. It is therefore crucial to prevent recurrence in order to conserve 'improved' fertility. Recurrence rates for endometrioma are reported from 11 to 32% within 1-5 years after excision. The recurrence rate is higher in patients with advanced endometriosis at surgery and in younger patients. Previous medical treatment for endometriosis prior laparoscopy is a risk factor for recurrence. Pregnancy soon after surgery has a protective effect for recurrence. The accumulating evidence suggests that the administration of oral contraceptives (OC), levonorgestrel-releasing intrauterine system (LNG-IUS) and a combination of gonadotropin releasing hormone (GnRH) analogue and OC may also have therapeutic benefits. Collectively, we propose that women should be well informed about the risks of endometrioma recurrence. We recommend that women who wish pregnancy should try conception as soon as possible. Further, we strongly advise hormonal therapy for patients, who do not want to conceive immediately, and until pregnancy is desired.

Recurrence of endometrioma, four months after laparoscopic excision: a case report

Endometriosis is a chronic disease that occurs roughly in 10% of women. Endometriosis can be found in anywhere in the body, but the most common lesions are in the ovary, known as endometrioma and accounting for 55% of endometriosis. Laparoscopic excision is the most frequently chosen form of treatment for endometrioma, to reduce pelvic pain and prevent loss of fertility. There is a problem with endometrioma recurrence after surgery, however. The recurrence rate is said to be almost 30% three to five years after surgery, and prophylaxis of endometrioma recurrence is thus a major issue. We experienced a case of endometrioma relapse in the same ovary after four months of laparoscopic surgery in a 25-year old woman who had suffered with endometrioma for more than seven years. The size of the endometrioma began to increase so we decided to operate after GnRHa therapy for six months. Two months after laparoscopic excision, we started to use oral contraceptives to avoid recurrence, but this occurred anyway, four months after the laparoscopic surgery, so a second laparoscopic excision was performed. We were sure to remove the whole lesion macroscopically, and again used oral contraceptives to prevent recurrence for two months after operation. One possible reason for the recurrence is that we started to use oral contraceptives after the resumption of menses. It may be that the most important way to prevent recurrence is to start medication therapy soon after the laparoscopic excision.

Long-term Adjuvant Therapy for the Prevention of Postoperative Endometrioma Recurrence

Long-term Adjuvant Therapy for the Prevention of Postoperative Endometrioma Recurrence

Long‐term adjuvant therapy for the prevention of postoperative endometrioma recurrence: a systematic review and meta‐analysis

Ovulation seems crucial in the pathogenesis of ovarian endometriomas. Therefore, suppression of ovulation should be protective against cyst relapse after excision. The objective of this systematic review was to assess the effect of long-term postoperative medical treatment on the risk of endometrioma recurrence. A MEDLINE search was conducted to identify all the comparative studies published in the last 12 years in the English language literature on the relation between long-term postoperative adjuvant therapy and risk of endometrioma recurrence. Of the 12 articles assessed in detail, four were finally selected based on surgery for endometriotic cysts, postoperative medical treatment use for ≥ 12 months vs. expectant management, and ultrasonographic and/or histological diagnosis of endometrioma recurrence. A total of 965 women were enrolled, 726 of whom were in three cohort studies and 239 in one randomized controlled trial. Oral contraceptives (OCs) were always used as postoperative adjuvant treatment. The absolute effect of postoperative OC use was assessed by comparing "always" and "never" users. A recurrent endometrioma was identified in 33 of 423 (8%) "always" OC users and in 117 of 341 (34%) women who underwent expectant management (pooled odds ratio 0.12; 95% confidence interval 0.05-0.29). To define the effect of duration of use, "always" users were compared with "ever" users, and "ever" with "never" users, with a pooled odds ratio of, respectively, 0.21 (95% confidence interval 0.11-0.40) and 0.39 (95% confidence interval 0.23-0.66). Postoperative OC use dramatically decreased the risk of ovarian endometrioma recurrence, especially in women who used OCs regularly and for prolonged periods.